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Histoplasma infection of abdominal aortic aneurysms
Abstract:
Fungal endarteritis resulting from progressive disseminated histoplasmosis may cause arterial aneurysms, or lead to infection of pre-existing aneurysms. Three patients with Histoplasma capsulatum infections of abdominal aortic aneurysms are reported. All had previous disseminated histoplasmosis and atherosclerotic peripheral vascular disease. All were considered cured of systemic infection when their aneurysms were discovered. Atherosclerotic vascular lesions may become infected during the course of systemic fungal disease and may serve as a haven for viable organisms in patients whose dissemination recurs despite seemingly adequate antifungal therapy. In treating these patients, resection of all infected arterial tissue, revascularization through uninfected tissues, and long-term antimicrobial therapy are recommended.
Insights
Fungal endarteritis from disseminated histoplasmosis can infect abdominal aortic aneurysms, even after initial treatment. Atherosclerotic lesions may harbor fungi, leading to recurrent infections requiring surgical intervention and long-term antifungal therapy.
Area of Science:
- Mycology
- Infectious Diseases
- Vascular Surgery
Background:
- Progressive disseminated histoplasmosis can lead to fungal endarteritis.
- Aneurysms, particularly abdominal aortic aneurysms, are susceptible to fungal infections.
- Atherosclerotic vascular disease is a common comorbidity in patients with disseminated fungal infections.
Observation:
- Three cases of Histoplasma capsulatum infection involving abdominal aortic aneurysms are presented.
- All patients had a history of disseminated histoplasmosis and atherosclerotic peripheral vascular disease.
- Patients were believed to be cured of systemic fungal infection prior to aneurysm diagnosis.
Findings:
- Atherosclerotic vascular lesions can serve as a nidus for fungal growth and recurrent infection.
- Fungal endarteritis in aneurysms can occur even when systemic infection appears resolved.
- Viable Histoplasma capsulatum organisms can persist in infected arterial tissue.
Implications:
- Early detection and aggressive management of fungal aneurysms are crucial.
- Treatment requires surgical resection of infected arterial segments and revascularization.
- Long-term antifungal therapy is essential to prevent recurrence and ensure cure.
- Understanding the role of atherosclerotic lesions in fungal dissemination is vital for patient management.